Questions You Were Afraid To Ask Your Gyno
Posted On Aug 29, 2016
There is nothing on the planet more embarrassing than a visit to the gynecologist. In case you disagree, let’s embellish. You are asked to strip naked, stick your feet in stirrups with your legs wide open while you hope to hell that nothing leaks or smells as your doctor pokes and prods around in your vagina. Who wants to ask any question after that ordeal? Escape from purgatory is more the game plan.
A survey of 391 women conducted by the Women¹s Sexual Health Foundation found that 72% of respondents are uncomfortable talking to their gynecologist about “the sexy stuff,” but 73% would rather die than ask the Doc, what’s up. “If something serious is going on, early diagnosis is CRUCIAL,” says Mary Jane Minkin, M.D., Clinical Professor of Obstetrics, Gynecology and Reproductive Sciences at Yale University School of Medicine, author of A Woman’s Guide to Sexual Health.
For peace of mind, we turned to Dr. Minkin to answer a few of those awkward questions for you;
I am recently single and worried about getting an STD. Should I get the HPV vaccine?
The HPV vaccine is approved by the FDA for girls and women ages 9 to 26 and is recommended by the CDC, the American College of Obstetrics, Gynecology and the American Academy of Pediatrics. There is actually a new improved vaccine active against 9 strains of HPV and protects against 75% of cancers so even better! Check out Gardisil 9 website to get the direct scoop. Remember, the HPV vaccine does not protect women from other STD’s so, be sure to use a condom.
Sometimes I have an odor the morning after sex or my period. Why does it happen and what can I do?
Don¹t worry, you aren’t dirty and washing with perfumed soap or douching won’t help – it will only make it worse! This happens because the vaginal pH has been thrown out of balance. Think of your vagina as a delicate ecosystem that needs to be maintained at a pH of 3.5 to 4.5. The pH of semen has a pH of 8 and blood has a pH of 7.4, so, when introduced to the vagina, an odor or itch can occur usually the morning after having sex or toward the end of your period. Lots of women douche to feel clean and fresh, but understand that water has a pH of 7, so while it might make you feel fresh for a short time, it won¹t solve the problem. Right after using the douche solution, make sure to balance the pH to normal. Over-the-counter, RepHresh Gel is clinically shown to restore the normal vaginal pH and eliminate vaginal odor.
I have a lot of discharge and irritation, but over the counter yeast medications don’t work.
Of women who self-treat for yeast: two thirds do not actually have a yeast infection at all: 1/3 have bacterial vaginosis (BV), a proliferation of “bad” bacteria, often caused by an unbalanced vaginal pH, and the other 1/3 have an allergic/irritant type reaction to scented products, etc. If you aren¹t sure whether your symptoms indicate BV or a yeast infection, you should absolutely see your doctor before you apply any over-the-counter treatment. Not only is bacterial vaginosis uncomfortable and frustrating, but untreated BV can also increase the risk of premature birth, pelvic inflammatory disease, and even sexually transmitted diseases. Once BV is diagnosed, a course of antibiotics is required to eliminate the symptoms. Recurrence rates are very high. The best way to prevent recurrent BV is to maintain a normal vagina pH.
I’m menopausal and have been experiencing discomfort.
The majority of postmenopausal women show an increase in vaginal pH within 12-24 months of discontinuing estrogen therapy or as estrogen levels decline naturally, and most women will also experience dryness. Replens Moisturizer can be used as often as every 3-5 days for comfort and to bring the pH to its normal levels.
What safe lubricants do you recommend?
An excellent option is Replens Silky Smooth or Wet Platinum; they are excellent silicone based lubricants. And for women who need longer lasting moisture, the moisturizer Replens (and all of these are over the counter) can be used regularly, on an ongoing basis, for moisture. One thing that women need to be reminded of, and actually many women are unaware is that moisturizers are to be used on an ongoing basis, whether or not a woman is sexually active. Common conditions needing on going moisture: menopause, and even breast feeding, can lead to dryness. But something like Replens Silky Smooth is an excellent adjunct for sexual activity.
Are birth control pills harmful in the long term and will it affect me from having a baby?
Birth control pills can be used as long as a woman wants to, and it does not diminish fertility. As a matter of fact, birth control pills are a good method for dealing with endometriosis; and endometriosis can adversely affect fertility – so the pill in these cases is actually quite helpful. And as far as IUD’s: no long term effects. One does need to remember that if one is using a pill or an IUD, it does not protect against STC’s: do if one is not in a mutually monogamous situation, always use a condom as well (because STD’s can have an adverse impact on fertility!)
What method of birth control do you think is the safest for the body?
Most women do very well with pills (or rings, or patches, or implants), or IUD’s, again the major issue is as above, using barrier methods for STD protection, of course. There are indeed a few women who should not take birth control pills: smokers over 35 (but hey, don’t smoke! then you can take the pill as cigarettes are much more dangerous!). Or women with uncontrolled high blood pressure, but most basically healthy women can take the pill. Everyone can use condoms with a contraceptive foam or gel, that protects against STD’s, and actually does a pretty good contraceptive job (like 98% effective)
How can I avoid urinary tract infection?
Unfortunately, being a woman puts us at increased risk for urinary tract infections: the tube from our bladders to the outside, called the urethra, is very short (much shorter than guys’ urethras)-so bacteria have an easy time getting into our bladders. So always stay well hydrated: keep drinking a lot of water. After sex, do get up and urinate. And there is some merit in cranberries: I usually have folks take the extract, as opposed to the juice, because of sugar: but cranberry does help keep bacteria from sticking to the walls of our bladder. If you keep having urinary tract infections (like 3 in six months, for example) check in with your health care practitioner to see about preventative measures.
If you have symptoms of a urinary tract infection (burning with urination, the need to urinate frequently, and get there in a hurry, getting up at night to urinate, or see blood in the urine) check in with your health care practitioner. Some providers recommend getting a urine culture done first; some just go ahead and treat with an antibiotic. And there is a medication called phenazopyridine (called AZO, and other brands) which is a soother for the bladder; it is available over the counter, and will take away your discomfort to let the antibiotic kick in and help cure you. So it’s not a bad idea to keep some of that in your house.
Ovarian cancer – are there any signs we need to look out for and what foods help with the health of your ovaries?
Alas, there really isn’t any data showing that any foods are particularly helpful. However, birth control pills are great as far as reducing the risk ovarian cancer. Women who take pills for even 5 years can reduce their risk of ovarian cancer by 50%; and the pill even reduces the rate of ovarian cancer in women who are BRCA positive!
As far as diagnosis; it is indeed somewhat tricky. The best symptom I think to pay attention to is if you feel full after eating only a few spoonsful of food (the fancy medical term is “early satiety”) or if you are feeling full quickly, tell your provider. Many folks talk about bloating -but the problem there is that bloating is such a non-specific symptom: and basically all of my patients tell me they’re bloated from time to time.
I heard that the Zika virus is now sexually transmitted – are there any other dangers other than to those that are pregnant that women should be aware of?
A couple of concerns: first of all, many folks who are infected don’t know it (they have a really mild case, or no symptoms at all), so someone could have been in an infected area, got infected, and is carrying it and doesn’t know it. And since many folks get pregnant “inadvertently” (they weren’t planning it)-someone could become infected by someone who didn’t know they were carrying the virus, and become infected sexually. So the best knowledge we have now is that if someone has been in South or Central America and they are having sex with a woman who is pregnant or might become pregnant soon, they should use a condom, just to be on the safe side (sounds strange using condoms in pregnancy, but….)
And a final piece of valuable advice from Dr Minikin; “If going to the gyno isn’t at the top of the list, it should definitely be right up there. A well-established relationship with your gynecologist is a MUST in order to have a successful visit. Remember to take your notes and questions in with you so you don’t forget anything. Talking about your anxieties can make the rest of the appointment a piece of cake.” We agree but piece of cake? Nah!